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. 2020 May;91(5):469-474.
doi: 10.1136/jnnp-2019-322280. Epub 2020 Mar 12.

Predictors of outcome in 1-month survivors of large middle cerebral artery infarcts treated by decompressive hemicraniectomy

Barbara Casolla  1 , Maeva Kyheng  2 , Gregory Kuchcinski  3 , Jean-Paul Lejeune  4 , Riyad Hanafi  3 , Marie Bodenant  5 , Didier Leys  6 , Julien Labreuche  2 , Etienne Allart  7 , Merce Jourdain  8 , Charlotte Cordonnier  1 , Hilde Henon  1
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Predictors of outcome in 1-month survivors of large middle cerebral artery infarcts treated by decompressive hemicraniectomy

Barbara Casolla et al. J Neurol Neurosurg Psychiatry. 2020 May.

Abstract

Background: Decompressive hemicraniectomy (DH) increases survival without severe dependency in patients with large middle cerebral artery (LMCA) infarcts. The objective was to identify predictors of 1-year outcome after DH for LMCA infarct.

Methods: We conducted this study in consecutive patients who underwent DH for LMCA infarcts, in a tertiary stroke centre. Using multivariable logistic regression analyses, we evaluated predictors of (1) 30-day mortality and (2) poor outcome after 1 year (defined as a modified Rankin Scale score of 4-6) in 30-day survivors.

Results: Of 212 patients (133 men, 63%; median age 51 years), 35 (16.5%) died within 30 days. Independent predictors of mortality were infarct volume before DH (OR 1.10 per 10 mL increase, 95% CI 1.04 to 1.16), delay between symptom onset and DH (OR 0.41, 95% CI 0.23 to 0.73 per 12 hours increase) and midline shift after DH (OR 2.59, 95% CI 1.09 to 6.14). The optimal infarct volume cut-off to predict death was 210 mL or more. Among the 177 survivors, 77 (43.5%) had a poor outcome at 1 year. Independent predictors of poor outcome were age (OR 1.08 per 1 year increase, 95% CI 1.03 to 1.12) and weekly alcohol consumption of 300 g or more (OR 5.30, 95% CI 2.20 to 12.76), but not infarct volume.

Conclusion: In patients with LMCA infarcts treated by DH, stroke characteristics (infarct volume before DH, midline shift after DH and early DH) predict 30-day mortality, while patients' characteristics (age and excessive alcohol intake) predict 1-year outcome survivors.

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Conflict of interest statement

Competing interests: DL reports participation in symposia organised by Boehringer Ingelheim, Bayer, BMS and Pfizer (honoraria paid to Adrinord), drug trials with Boehringer-Ingelheim (honoraria paid to the hospital); he is vice editor of the European Stroke Journal (honoraria paid to Adrinord), vice president of the scientific committee of the Fondation de Recherche sur les AVC (unpaid); is a member of the scientific committee of the Servier Institute (unpaid); and was member of DSMBs for institutional trials (unpaid) (INCH, Germany; TARDIS, United Kingdom; and TO-ACT, the Netherlands). He received research support from a grant of the University of Heidelberg (Germany) for the ECASS4 trial. CC served for advisory boards (Bayer, Medtronics and Daiichi-Sankyo) and as investigator for clinical trials (Astra-Zeneca, Boehringer-Ingelheim, Daiichi-Sankyo and Pfizer). All fees were paid to ADRINORD or the Lille University Hospital research account; no personal funding.

Comment in

  • Big strokes can cause big problems.
    Furie KL, Sheth KN. Furie KL, et al. J Neurol Neurosurg Psychiatry. 2020 May;91(5):453. doi: 10.1136/jnnp-2020-322964. Epub 2020 Mar 12. J Neurol Neurosurg Psychiatry. 2020. PMID: 32165375 No abstract available.

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